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Recommendation
| Know that modalities for which there is limited evidence for effectiveness or evidence against their effectiveness include anxiolytics, clonidine (which, although it has the strongest evidence of benefit, should be considered a second-line therapy due to side effects), mecamylamine, lobeline, naltrexone, and silver acetate.
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Evidence:
- A Cochrane review of six RCTs of clonidine for smoking cessation found an OR of 1.89 (CI, 1.30 to 2.74) in favor of clonidine. There was a high incidence of dose-dependent side effects, and the period of follow-up for determining cessation rates was only 12 weeks (57).
- A Cochrane review of lobeline for smoking cessation identified no RCTs with at least 6-month follow-up (58).
- A Cochrane review included a meta-analysis of the results of two studies of silver acetate vs. placebo for smoking cessation. There was no significant effect of silver acetate (OR, 1.05, CI 0.63-1.73) (59).
- A Cochrane review of seven trials of anxiolytic therapy for smoking cessation, with at least 6-month follow-up, identified insufficient evidence of benefit (60).
- A Cochrane review of four RCTs of naltrexone for smoking cessation, with at least 6-month follow-up, identified no signficant effect (OR, 1.26 [CI, 0.80 to 2.01]) (61).
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Comments:
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| Edward Ellerbeck, MD, MPH, editorial consultant, has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Kumanan Wilson, MD has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations.
Steven E. Weinberger, MD, FACP, Acting Editor, PIER, has stock holdings in Glaxosmithkline and Abbott. |
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The information included herein should never be used as a substitute
for clinical judgment and does not represent an official position of
ACP. Because all PIER modules are updated regularly, printed web pages
or PDFs may rapidly become obsolete. Therefore, PIER users should
compare the date of the last update on the website with any printout
to ensure that the information being referred to is the most current
available.
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PIER is copyrighted (c) 2009 by the American College of Physicians,
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Smoking Cessation
> Effectiveness/Harms of Counseling or Intervention on Changing Behavior
